背景:肝静脉压力梯度(HVPG)是诊断门静脉高压(PH)的金标准,测量过程中的侵入性和潜在风险限制了其广泛使用。
目的:为了研究PH中计算机断层扫描(CT)灌注参数与HVPG的相关性,并定量评估经颈静脉肝内门体分流术(TIPS)前后肝脾实质的血供变化。
方法:本研究招募了24例PH相关性消化道出血患者,所有患者均在2周内进行TIPS手术前后的灌注CT检查。CT灌注定量参数,包括肝血容量(LBV),肝血流量(LBF),肝动脉分数(HAF),脾血容量(SBV)和脾血流量(SBF),在TIPS之前和之后进行测量和比较,并比较了临床上有意义的PH(CSPH)和非CSPH(NCSPH)组之间的定量参数。然后分析CT灌注参数与HVPG的相关性,有统计学意义为P<0.05。
结果:对于TIPS后的所有24名PH患者,CT灌注参数显示LBV下降,增加HAF,SBV和SBF,LBF无统计学差异。与NCSPH相比,CSPH显示较高的HAF,其他CT灌注参数无差异。TIPS前HAF与HVPG呈正相关(r=0.530,P=0.008),而其他CT灌注参数与HVPG和Child-Pugh评分无相关性。
结论:HAF,CT灌注指数,与HVPG呈正相关,CSPH高于TIPS前的NCSPH。虽然增加了HAF,SBF和SBV,降低了LBV,是在TIPS之后发现的,这是一种潜在的非侵入性成像工具,用于评估PH。
BACKGROUND: Hepatic venous pressure gradient (HVPG) is the gold standard for diagnosis of portal hypertension (PH), invasiveness and potential risks in the process of measurement limited its widespread use.
OBJECTIVE: To investigate the correlation of computed tomography (CT) perfusion parameters with HVPG in PH, and quantitatively assess the blood supply changes in liver and spleen parenchyma before and after transjugular intrahepatic portosystemic shunt (TIPS).
METHODS: Twenty-four PH related gastrointestinal bleeding patients were recruited in this
study, and all patients were performed perfusion CT before and after TIPS surgery within 2 wk. Quantitative parameters of CT perfusion, including liver blood volume (LBV), liver blood flow (LBF), hepatic arterial fraction (HAF), spleen blood volume (SBV) and spleen blood flow (SBF), were measured and compared before and after TIPS, and the quantitative parameters between clinically significant PH (CSPH) and non-CSPH (NCSPH) group were also compared. Then the correlation of CT perfusion parameters with HVPG were analyzed, with statistical significance as P < 0.05.
RESULTS: For all 24 PH patients after TIPS, CT perfusion parameters demonstrated decreased LBV, increased HAF, SBV and SBF, with no statistical difference in LBF. Compared with NCSPH, CSPH showed higher HAF, with no difference in other CT perfusion parameters. HAF before TIPS showed positive correlation with HVPG (r = 0.530, P = 0.008), while no correlation was found in other CT perfusion parameters with HVPG and Child-Pugh scores.
CONCLUSIONS: HAF, an index of CT perfusion, was positive correlation with HVPG, and higher in CSPH than NCSPH before TIPS. While increased HAF, SBF and SBV, and decreased LBV, were found after TIPS, which accommodates a potential non-invasive imaging tool for evaluation of PH.